Vascular Trauma KSU外伤血管.pptVIP

Neck Trauma Most commonly penetrating type. Associated vascular injury in 30% Thank You Badr Aljabri, MD, FRCSC Assistant professor and consultant Vascular Surgery Vascular Trauma Badr Aljabri, MD, FRCSC Associate professor and consultant Vascular Surgery General Principles Always start with ABC Large IV pore lines External compression to control bleeding Look for hard signs of arterial injuries Try to answer !! Is this blunt or penetrating injury ? Is this Arterial or Venous injury ? Should I take the patient to the operating room or do further investigations? Is it Hospital Vs community based vascular injury? Is this Arterial or Venous injury ? Arterial Pulse examination Hard signs Pulsetile ext. bleeding Absent distal pulses. Expanding hematoma Distal ischemia Thrill or bruit Is this Arterial or Venous injury ? Venous Low pressure dark blood external bleeding Non-expanding hematoma Shock is rare unless associated with arterial injury Should I take the patient to the operating room or do further investigations? Any patients with these following signs should not wait !!!! External bleeding Expanding hematoma with shock Limb ischemia Hospital based trauma Venous : Central venous access hematoma Guide wire dislodgment Arterial : catheterization - Psudoaneurysm - Arterial dissection Thrombosis - AV Fistula formation - Distal Embolization Psudoaneurysm walled off extra- luminal circulation of the blood as a result of arterial wall disruption. Psudoaneurysm Conservative U/S guided compression U/S guided thrombin injection Surgery Psudoaneurysm Indications for surgical intervention: 1) Evidence of ongoing bleeding 2) Associated limb ischemia 3) Nerve compression 4) Need for aggressive anticoagulation 5) Threatened skin viability 6) Psudoaneurysm surrounded by large hematoma 7